Provider Demographics
NPI:1346340726
Name:JEFFERS, VICTORIA W (PHD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:W
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 WINDING BROOK ROAD
Mailing Address - Street 2:
Mailing Address - City:CALIFON
Mailing Address - State:NJ
Mailing Address - Zip Code:07830
Mailing Address - Country:US
Mailing Address - Phone:908-832-6679
Mailing Address - Fax:908-832-6679
Practice Address - Street 1:670 WINDING BROOK ROAD
Practice Address - Street 2:
Practice Address - City:CALIFON
Practice Address - State:NJ
Practice Address - Zip Code:07830
Practice Address - Country:US
Practice Address - Phone:908-832-6683
Practice Address - Fax:908-832-6679
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSIO1861103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ607294Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST